Tuesday, December 10, 2019

Comments by Suman Fernando

Showing 5 of 5 comments.

  • Sorry a bit late in commenting on points made by Akiko about MHAct Review. Based on much discussion (study group on counteracting racism in MH systems, conference on MHAct Review and Institutional racism attended by nearly 130 people etc etc.), subsequent to the release on my book (https://www.springer.com/gb/book/9783319627274), I suggest that legal action (i.e. MHAct) can indeed play a part in counteracting institutional racism. Legislation can influence both practice and attitudes by setting standards and shifting the state-sponsored terms of acceptability, in the way Race Relations legislation, introduced in the 1970s altered employment practices and thence attitude of society. We can do this (for example) by regulating the process of making diagnoses and their ‘power’; regulating the skill base of professionals (who are currently totally dominated by white-supremacist, ‘white knowledge’); creating effective system of tribunals that are driven by principles of human rights, including by anti-discriminatory practice and combatting institutional racism; and shifting the culture of psychiatry and clinical psychiatry by regulating the professions – as police culture was nudged to change to some degree after the Macpherson report of 1999, and so on . What seem to be needed is in-depth understanding of what institutional (‘cultural’) racism really means (I am not sure many people in positions of power have this understanding). This is really a form of indirect racism unlike the direct in-your-face racism we all recognise so easily and counteracting such racism has to be primarily by indirect action (of which legal action it one). And of course there has to be a political will to institute change and for people leading reviews (like MHAct Review) to “TELL IT HOW IT IS” to start with. Will Simon Wessely do that?

  • I am surprised that the while the Division of Clinical Psychology of UK intends to launch this report in the US in its present form. The editor is about to re-write the report – or at least this is what she has told black and ethnic minority people in UK who have objected to some of the content of the report, the way it excluded black voices from contributing to it, and how the report has drawn only on ‘white knowledge’ in its writing. The editor of the report has issued an apology (http://www.sumanfernando.com/Apology%20by%20Anne%20Cooke.pdf) and (a) offered to work with black and minority ethnic people in UK in deleting parts of the report that are offensive to black British people seen in the report as ‘the other’ whose ‘home countries’ are elsewhere than in UK etc. , and to correct inaccurate information (for example that black British are excessively diagnosed as ‘schizophrenic’ in their ‘home countries’) and (b) offered to redress the fact that black British psychologists and service users and others were excluded from contributing to the report. In fact black and minority ethnic people, including members of the DCP, wee not even told about the report and not invited to its launch in UK.

    Black people in UK have been struggling for many years to deal with the oppressive diagnosis ‘schizophrenia’ which, as in the USA (see Jonathan Metzl’s The Protest Psychosis; how schizophrenia became a black disease), is given predominantly to black people. The DCP seems to have ignored this fact and more seriously, excluded the voices of black and minority ethnic people in UK from being heard in this report. I see that Toni Morrison is listed as having been a ‘report author’. It would be interesting to know whether she was appraised of the way ‘schizophrenia’ is used as weapon of oppression of black people in the UK and what her contributions was in discussions. Has she been told of the objections to the report by black people in the UK?

  • Thanks Lucy and Dave for pointing to the sections in the DCP report that refer to non-western cultures (para 1.3 pg. 14) and the experiences of black people being diagnosed as ‘schizophrenic’ (para 6.3 pg. 45). There is indeed reference to beliefs in ‘supernatural or religious forces’ (pp. 12, 16, 20) but surely this applies to everyone not just ‘ethnic minorities’ and other groups that suffer discrimination?

    Reading the sections you draw attention to, I am horrified by the language used implying that black people in UK are outsiders who do not belong to British society; and by the inaccuracies that obscure the problems that British black people face in contending with the diagnosis of schizophrenia. In para 1.3, while stating that people from ‘particular cultures’ believe in ‘ghosts, evil spirits and aliens … [and] … demon possession’, the report suggests patronisingly that ‘we’ (presumably white Europeans) should ‘take into account ‘their’ (of the foreign ‘other’?) ‘upbringing and cultural background’.

    In para 6.3, the report refers to ‘migrant groups particularly people of African and African-Caribbean origin’ being diagnosed with schizophrenia, ‘even though rates in their home countries are generally similar to those in the UK’ (no reference given). In fact, it is not ‘migrants’ (many immigrants are now white people from Europe) who are over-represented among people diagnosed as ‘schizophrenic’ but the British black population born in UK, whose home country is the UK. The rate of diagnosis of ‘schizophrenia’ in the British black population is higher than that among black migrants of earlier years from Africa and the Caribbean. If by ‘home countries’ is meant the Caribbean (where systems of training are similar to that in UK, being dependent on Western psychiatry and psychology), the evidence is that the rates among black people in the Caribbean are lower than those reported among white British people in UK and considerably lower than those among black British (I can give references). In fact, there was a study at the Institute of Psychiatry in London (published in 1999) which showed that a Black Jamaican psychiatrist disagreed in 45% of instances with the diagnosis of ‘schizophrenia’ among black British patients at the IOP made by British psychiatrists. The point is that the issue is (mainly) one of institutional racism and not migration or ‘culture’. This may of course be an issue in North America too—see the book by Jonathan Metzl The Protest Psychosis How Schizophrenia became a Black Disease.

    I think that the report needs re-writing, keeping the good bits but including a critical analysis of how the diagnosis ‘schizophrenia’ play out in its application to black and possibly other racialized groups in UK. Otherwise, as Phil says, if is of little or no relevance to 14% of British society – and I think in its present form it is an insult to black British people. In any case the DCP should make an official apology for issuing such a report in the first place.

  • Just to correct a wrong impression that may be given by an earlier post, there was apparently no consultation (before the report was drawn up) with people within DCP who may have known something about BME views, such as Zenobia Nadirshaw or any of the members of the BPS’s former ‘Race and Culture Faculty’ – a body I believe that had been disbanded a short while ago without consultation with its members! And of course no attempt had been made to consult service users / survivors from BME communities. So while welcoming the acknowledgment of some DCP members that a mistake was made and an apparent wish to work on a new more inclusive report, it does seem there are institutional problems (i.e.’ institutional racism’) that DCP may wish to address too. Way back in late 1990’s (soon after McPherson pointed out that most British institutions were institutionally racist), I think the Royal College of Psychiatrists invited a consultancy to report on institutional practices that led to institutional racism of this sort and made some changes as a result, such as introducing ethnic monitoring of its membership, membership exams etc. – although I must say did not manage at that time to bring in race equality into training curricula.